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https://www.arca.fiocruz.br/handle/icict/51518
MORTALITY FROM CONGENITAL ZIKA SYNDROME: NATIONWIDE COHORT STUDY IN BRAZIL
Autor(es)
Paixão, Enny S.
Cardim, Luciana L.
Costa, Maria C. N.
Brickley, Elizabeth B.
Carvalho-Sauer, Rita C. O. de
Carmo, Eduardo H.
Andrade, Roberto F. S.
Rodrigues, Moreno S.
Veiga, Rafael V.
Costa, Larissa C.
Moore, Cynthia A.
França, Giovanny V. A.
Smeeth, Liam
Rodrigues, Laura C.
Barreto, Mauricio L.
Teixeira, Maria G.
Cardim, Luciana L.
Costa, Maria C. N.
Brickley, Elizabeth B.
Carvalho-Sauer, Rita C. O. de
Carmo, Eduardo H.
Andrade, Roberto F. S.
Rodrigues, Moreno S.
Veiga, Rafael V.
Costa, Larissa C.
Moore, Cynthia A.
França, Giovanny V. A.
Smeeth, Liam
Rodrigues, Laura C.
Barreto, Mauricio L.
Teixeira, Maria G.
Afiliação
London School of Hygiene and Tropical Medicine. London, UK / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
London School of Hygiene and Tropical Medicine. London, UK.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. Division of Birth Defects and Infant Disorders. Atlanta, GA, USA.
Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.
London School of Hygiene and Tropical Medicine. London, UK.
London School of Hygiene and Tropical Medicine. London, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
London School of Hygiene and Tropical Medicine. London, UK.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. Division of Birth Defects and Infant Disorders. Atlanta, GA, USA.
Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.
London School of Hygiene and Tropical Medicine. London, UK.
London School of Hygiene and Tropical Medicine. London, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Resumo em Inglês
BACKGROUND
Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spec-
trum of clinical presentation referred to as congenital Zika syndrome. Data on
survival among children with congenital Zika syndrome are limited.
METHODS
In this population-based cohort study, we used linked, routinely collected data in
Brazil, from January 2015 through December 2018, to estimate mortality among
live-born children with congenital Zika syndrome as compared with those without
the syndrome. Kaplan–Meier curves and survival models were assessed with ad-
justment for confounding and with stratification according to gestational age,
birth weight, and status of being small for gestational age.
RESULTS
A total of 11,481,215 live-born children were followed to 36 months of age. The
mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000
person-years among live-born children with congenital Zika syndrome, as com-
pared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those
without the syndrome. The mortality rate ratio among live-born children with
congenital Zika syndrome, as compared with those without the syndrome, was
11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or
with a birth weight of less than 1500 g, the risks of death were similar regardless
of congenital Zika syndrome status. Among infants born at term, those with con-
genital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as
those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-
years). Among infants with a birth weight of 2500 g or greater, those with con-
genital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as
those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-
years). The burden of congenital anomalies, diseases of the nervous system, and
infectious diseases as recorded causes of deaths was higher among live-born
children with congenital Zika syndrome than among those without the syndrome.
CONCLUSIONS
The risk of death was higher among live-born children with congenital Zika syn-
drome than among those without the syndrome and persisted throughout the first
3 years of life. (Funded by the Ministry of Health of Brazil and others.)
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